SLR - August 2016 - Kevin J. Denis
Reference: Ebraheim NA, Siddiqui S, Raberding C. A Single-Incision Fasciotomy for Compartment Syndrome of the Lower Leg. J Orthop Trauma. 2016 Jul; 30(7): e252–5.Scientific Literature Review
Reviewed By: Kevin J. Denis, DPM
Residency Program: Aria Health
Podiatric Relevance: Acute compartment syndrome is a medical emergency that requires emergent fasciotomy to relieve the increased intra-compartmental pressures. There are several two-incisional and single-incisional approaches described in the literature each with its own relative advantages and disadvantages.
Methods: The authors retrospectively reviewed 184 consecutive fasciotomies performed from 2010 to 2014 at a level 1 trauma center by a single surgeon. Thirty patients underwent a single-incisional fasciotomy for decompression of all 4 compartments. The fasciotomy was made midway between the anterior tibial crest and fibula for the distal two-thirds of the leg. Once the anterior and lateral compartments are identified, fasciotomies are performed of the overlying deep fascia. The superficial posterior compartment is then visualized and released through the lateral compartment with the peroneals retracted anteriorly. The deep posterior compartment is approached through the anterior compartment by reflecting the tibialis anterior laterally off the tibia. Once the intraosseous membrane is identified, it is incised and a Cobb is used to perform the full release.
Results: The authors retrospectively reviewed 184 consecutive fasciotomies. Thirty patients underwent a single-incisional fasciotomy for decompression of all 4 compartments. Twenty-seven patients had associated fractures (24 closed, 3 open), 2 patients with soft-tissue injuries and 1 patient with spontaneous development of compartment syndrome. To evaluate the efficacy, they looked at outcomes related to the fasciotomy itself instead of the reduction and fixation procedure. In the immediate postoperative period, the authors looked at sensation and infection. Nineteen of the 30 patients had altered sensation around the fasciotomy site. One of the 30 patients had a superficial infection. One patient had long-term deep peroneal nerve damage with paresthesias of the dorsal first and second toe at the 8-week follow-up. Seven patients had tethered scars and 3 with tethered tendons. There were no cases of chronic infection, osteomyelitis, or amputation. Eight patients underwent delayed primary closure with the remaining 22 patients underwent split thickness skin grafting.
Conclusions: The paratibial single-incisional fasciotomy is a fast and reliable technique to release all 4 compartments of the lower leg in the treatment of acute compartment syndrome.